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New Immunotherapy Approach for Breast Cancer Shows Promise

The treatment combines a technique called cryoablation, or freezing of the tumor, with an immunotherapy drug.

A new form of immunotherapy treatment — the first of its kind for breast cancer — is showing promising results in early research.

The treatment combines a technique called cryoablation, or freezing of the tumor, with an immunotherapy drug that has already proved effective in advanced melanoma, an aggressive form of skin cancer. The results of this early-stage investigation were presented yesterday at the American Society of Clinical Oncology ’s annual meeting in Chicago.

“Attempts have been made to harness the immune system as an anticancer mechanism for more than 100 years, but progress in this field has been relatively modest until recently,” says Heather McArthur, a Memorial Sloan Kettering breast oncologist who was the senior author of two studies reporting the findings. “However, given the recent successes in treating melanoma, we are looking at immune therapies in other types of solid tumors, including breast cancer.”

Making Tumors More Accessible to Treatment

The drug employed in this study is ipilimumab (Yervoy®), which was developed largely by Memorial Sloan Kettering investigators for the treatment of melanoma. Ipilimumab works by blocking a protein called CTLA-4, which normally puts the brakes on the immune system. If the brakes are turned off, the immune system is able to mount a robust response and ideally destroy tumor cells.

The role of ipilimumab is being actively investigated in a number of solid tumors “Our approach is unique, however, in that it combines tumor freezing with immune stimulation. The treatment is based on that idea that a tumor mass is difficult for the immune system to infiltrate and digest. But if you break the tumor mass down into tiny fragments, the immune system will have an easier time processing it,” Dr. McArthur explains.

In this technique, investigators use cryoablation to break the tumor into smaller pieces. Using MRI for guidance, a small needle is inserted into the tumor to create an ice ball, which freezes it and breaks it into tiny fragments.

The patients are also given a single dose of ipilimumab. The intent of the treatment is to enable the immune system to recognize breast cancer fragments, remember that information, and consequently seek out and destroy any tumor cells that may appear in the body if the cancer recurs months or even years after surgery.

Evaluating Safety with a Stepwise Approach

The women who participated in this pilot study had newly diagnosed, early-stage disease and had already decided to have a mastectomy.

The first group of six patients underwent cryoablation alone to make sure that it wouldn’t interfere with the ability to later undergo mastectomy, which is intended to cure the cancer. The second group of six underwent immune therapy alone, receiving a single dose of ipilimumab to ensure there were no unexpected side effects.

After confirming that the two approaches were safe on their own, six additional patients were given the full treatment of cryoablation and a single dose of ipilimumab before their surgery. The women were then followed for three months to measure their immune responses and to make sure the treatment did not compromise the standard of care.

“The primary goal of the study was to show that we can combine the two strategies of cryoablation and immune stimulation without compromising a woman’s ability to have her curative-intent surgery, and that’s what we were able to demonstrate in this study,” Dr. McArthur said.

“This was also a unique opportunity to be able to collect tissue samples from before any treatment had been given and then again afterward, and to compare the changes in the tumor cells,” she continued. “Based on the tissue and blood analyses, performed in partnership with [physician-scientist] Jedd Wolchok and our collaborators at the Immune Monitoring Facility, we found that there was indeed a signal of immune activity with the combination of cryoablation and immune stimulation.”

Based on those findings, Dr. McArthur expects a larger study to launch sometime in the fall.

This research was supported by the Terri Brodeur Breast Cancer Foundation and the Cure Breast Cancer Foundation. Bristol-Myers Squibb supplied the drug for the study.

Comments

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Catherine Javier

Jun 15, 2014 • 4:57 PM

Hi tita hope you find this helpful.
This is a good article in hopes for better treatment option.

Stephen Trevathan

Jun 18, 2014 • 1:56 AM

Speaking of promise, have you read the story about Melinda Bachini? This 43 woman was facing death as her advanced-stage cancer had begun to metastasize, but her doctors were able to able to obtain the genome sequence for her disease and pinpoint the immune response cells that would attack a specific mutation within the cancerous cells. It's a story worth looking into if you want to know more about the applications for immunotherapy: http://www.knowcancer.com/blog/doctors-saved-woman-immunotherapy/

Zoe Moghaddam

Jul 3, 2014 • 3:02 PM

Hi. I had 7 weeks ago a lumpectomy and one of my lymph node is positive . My oncotype result is 20. Do you think I need this treatment or CmF to TC?
Thank you.

Zoe, thank you for your comment. Unfortunately we cannot answer specific personal medical questions such as this, which are best left to a medical professional familiar with an individual patient’s entire history. If you would like to make an appointment to speak with one of our experts you can contact our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment.

Susan

Jul 5, 2014 • 6:19 PM

I do hope that some of the research includes those patients with metastatic breast cancer, especially those who have been in constant treatment for so many years. It would be wonderful for them !

Robyn

Aug 10, 2014 • 6:15 PM

Very exciting news. Keep up the great work, thank you all for your dedication to curing this awful disease.

Maria Canino

Aug 21, 2014 • 10:35 AM

A dear friend has end stage metastatic breast cancer. She is currently not under an oncologist’s care having eschewed radiation and chemotherapy early on, but undergoing a mastectomy. She resides in Puerto Rico and is too weak to travel to NY. Is there a colleague here in Puerto Rico with whom you are collaborating or is conducting clinical trials for which she would want to participate. Thank you so very much for your dedicated work.

Dear Maria, we are sorry to hear about your friend’s diagnosis. It was recently announced that the University of Puerto Rico is working with the National Cancer Institute (NCI) and MD Anderson in Houston to bring superior, comprehensive cancer care to the island. They are building a new facility in PR but it won’t be open until 2016. Having said that, UPR may have specialists who can help her now - they mention here that they are conducting clinical trials for people with breast cancer: http://www.cancer.gov/newscenter/spotlightonscientists/CancerCenterPuer….

Thanks you for this article and the multi-media panel session on immunotherapy treatment of breast cancer tumours. My wife is now 3 years breast cancer free after having an operation and 6 rounds of chemotherapy, but immunotherapy was not available at that time. We are based in Queensland, Australia. Is there any research yet that indicates whether the new immunotherapy treatment you have trialled for breast cancer tumours has a place after chemotherapy and surgery to reduce risk of recurrence? As an added complication, my wife also suffers from rheumatoid arthritis so we are always having to balance the impacts of the cancer and RA treatments.
Thanks Graeme

Dear Graeme, we are happy to hear that your wife is three years cancer free. Immunotherapy for breast cancer is still early and investigational, and researchers are still gathering evidence to confirm whether, when, and in whom it would be helpful. For more information about immunotherapy for breast cancer, you may call the US National Cancer Institute at 1-800-4-CANCER or go to www.cancer.gov, which offers a database of clinical trials results and may be of interest. Here’s the breast cancer trial results page, which is updated frequently: http://www.cancer.gov/clinicaltrials/results/type/breast

We hope this is helpful. Thank you for your comment.

AnonymousLW

Jun 3, 2015 • 9:30 AM

Does MSK currently offer immunotherapy to mestatic breast cancer patients?

Erin, the trial discussed in this study has already closed, but a larger, randomized trial is expected to open soon. If you’d like to arrange for a consultation at MSK to find out more about this and other trials for breast cancer, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment.

Padmini

Apr 12, 2016 • 6:23 AM

I'm from India and I'm diagnosed of breast cancer last year. Do you offer consultation for patients from abroad? I cannot travel to US.
How do I reach out to doctors in MSKCC?

I was diagnosed with stage three ductal Breast cancer. I am suppose to undergo double mastectomy Oct 12. Are you able to point me to a local facility where I might be treated this way? Time is of the essence. I am in Birmingham, AL

Hi Leslie, to look for immunotherapy trials for breast cancer in your area, we recommend you speak with your doctors or go to www.clinicaltrials.gov. This database maintained by the National Institutes of Health lists clinical trials throughout the US and the rest of the world. Best wishes to you, and thank you for your comment.

Rev Susan Miller

Apr 17, 2018 • 12:02 PM

43 yo woman metastatic breast cancer to liver,has received strong chemo since Jan 2018 with no improvement. Can she be a candidate for immunology? She lives in Meadville PA.